1235600255 NPI number — ABDOULAYE SOUMAHORO

Table of content: ABDOULAYE SOUMAHORO (NPI 1235600255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235600255 NPI number — ABDOULAYE SOUMAHORO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUMAHORO
Provider First Name:
ABDOULAYE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235600255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 WEBSTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAWTUCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02861-1016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-359-0720
Provider Business Mailing Address Fax Number:
401-495-4022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 WEBSTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02861-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-359-0720
Provider Business Practice Location Address Fax Number:
401-495-4022
Provider Enumeration Date:
12/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172A00000X , with the licence number:  2310551 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2310551 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com